Young children in South Africa are more likely to live in poverty, suffer from food insecurity and malnutrition, and die before their fifth birthday than they were before the COVID-19 pandemic.
This is according to the South African Early Childhood Review 2024, which tracks data on the status of children under six years, and is jointly published by Ilifa Labantwana; the Children’s Institute at the University of Cape Town; the Department of Planning, Monitoring and Evaluation in the Presidency; the Department of Basic Education; the Grow Great Campaign; and DataDrive2030.
“The COVID-19 pandemic erased gains made for young children in South Africa, presenting a massive setback we have not fully recovered from,” said Dr Katharine Hall, Senior Researcher at the Children’s Institute at the University of Cape Town.
All essential services for young children were affected by the lockdown. Primary healthcare services have recovered but we still face backlogs in birth registration and early access to social grants. Pre-school attendance remains below pre-COVID-19 levels and there are worrying indications that child malnutrition and mortality rates have risen, alongside rising poverty rates.
Leadership on early childhood development by the Department of Basic Education, the National Planning Commission and social partners is already showing many green shoots. Building on this, the new Government of National Unity presents an unmissable opportunity to improve coordination among the national and provincial departments responsible for ECD and accelerate the expansion of essential and quality ECD services.
“This review comes at a critical juncture in our nation’s journey towards realising universal access to quality early ECD, especially for our most vulnerable children,” said Ms Kulula Manona, Chief Director for Foundations for Learning in the DBE.
Children’s long-term development relies on a package of interrelated and integrated services covering the period from conception to six years of age: healthcare; nutritional support; support for primary caregivers; social services and protection; and early learning.
More children are now at serious risk of malnutrition
“Nearly 40% of children under age six now live in households below the food poverty line, and half a million more children are at serious risk of malnutrition than before COVID-19. Children in rural parts of the country have historically been the most vulnerable to poverty and poor nutrition, but now we are seeing a rise everywhere – even in the wealthier urban provinces of Gauteng and the Western Cape,” said Dr Edzani Mphaphuli, Executive Director of Grow Great.
Malnutrition is difficult to reverse, has lifelong consequences, and can be fatal. Stunting is the result of chronic undernutrition. It is the most common form of malnutrition in South Africa, affecting one in four children under five years.
“Stunting leads to inequality because stunted children are more likely to grow up to be poor, unskilled, unemployed, and suffer from chronic diseases,” said Dr Mphaphuli.
“We will not achieve our national development goals without ensuring young children’s food security. The new administration must prioritise increased social assistance to young children and expectant mothers, as well as nutrition programmes delivered directly through health services and early learning programmes.”
Access to quality early learning remains unequal. South Africa now has data to measure and address the gaps
The DBE, which assumed responsibility for ECD in 2022, spearheaded the 2021/22 ECD Census, the Thrive by Five Index 2021, and the ECD Baseline Assessment of pre-primary learning.
“Nationally, around 1.15 million children aged three to five years are not enrolled in any kind of early learning programme. The most likely reason is poverty. By not attending preschool, poorer children lose out on important early learning opportunities making it difficult for them to transition successfully into school,” said Sonja Giese, Executive Director of DataDrive2030.
A three-year-old child in the wealthiest quintile is 1.6 times more likely to attend an early learning programme (ELP) than their same-age peer in the poorest quintile. The quality of early learning at these sites is also of concern because many ELPs lack the necessary resources to deliver effective programmes.
“The value of the government early learning subsidy has been severely eroded by inflation. Until there is a significant increase in funding and support for early learning programmes, we will continue to see poor outcomes for young children,” added Giese.
The Thrive by Five Index 2021 found that only 46% of four-year-olds attending an ELP were developmentally on track for their age.
Maternal and child health services were hit hard by COVID-19 but have mostly recovered
Nearly 90% of children under the age of six in South Africa rely on the public health system.
“Antenatal attendance, postnatal follow up and immunisation rates all dropped during the pandemic. These health services had mostly recovered or even improved by 2022, but we need to ensure that there is continuity in maternal and child health services even in times of crisis,” said Dr Colin Almeleh, Director at Ilifa Labantwana.
South Africa’s HIV/AIDs treatment programme continues to deliver results, with over 95% of eligible pregnant women receiving antiretrovirals, resulting in very low rates (0.2%) of mother-to-child transmission of HIV.
According to preliminary estimates by the Medical Research Council, 30 out of every 1,000 infants born alive did not live to their first birthday in 2022, and the under-five mortality rate increased from a low of 29 per thousand live births in 2020 to 40 in 2022.
This is a reversal of the overall improvements in under-five and infant mortality rates in the decade leading up to the pandemic. The underlying reasons for rising mortality are unclear, but poverty and malnutrition, which also increased over the period, are likely to be contributing factors.
More poor children are being excluded from receiving the Child Support Grant
In 2023, 4.27 million children under the age of six received the Child Support Grant (R530 per month), representing 63% of all children in this age group.
“The Child Support Grant has received annual increases that have not kept pace with food inflation and is no longer able to cover the minimum cost of feeding and clothing a child,” said Dr Hall.
“Worryingly, we have seen a real decrease in the grant take-up among infants,” she added.
A key reason for the decline is a lack of identity documentation for mothers and birth registration delays for the baby. The estimated number of unregistered infants in South Africa leapt from 190,000 in 2019 to 255,000 in 2020. Even after a considerable recovery of birth registration rates in 2021, grant uptake for infants continued to fall. In March 2024, nearly 200,000 fewer infants were receiving the grant than in March 2020 when South Africa went into lockdown.
Eligible children must receive the Child Support Grant from birth to fully maximise the associated developmental benefits such as improved nutrition and health outcomes. This will require better linkages between the health facilities where 83% of births take place, the Department of Home Affairs and the South African Social Security Agency (SASSA).
Strengthening efforts to ensure that all young children thrive
Early childhood development is central to reducing socioeconomic inequality. Despite the many achievements of the post-apartheid period, progress across the various domains of early childhood development is unacceptably slow.
“The high rates of poverty, malnutrition and exclusion from services are not new: they are long-term challenges that preceded the pandemic, and were exacerbated by it. Recovery is not just about resuming business as usual – it has to be about finding different and better ways of ensuring that a holistic package of services and support reaches all young children,” added Dr Hall.
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The South African Early Childhood Review 2024 can be downloaded from the Ilifa Labantwana website, or the Children’s Institute website.
- To arrange an interview with Ilifa Labantwana, contact: Thobile Zulu-Molobi (Communications Manager) at thobile@ilifalabantwana.co.za or 073 123 6287.
- To arrange an interview with the Children’s Institute (University of Cape Town), contact: Leanne Jansen-Thomas (Communications Specialist) at leanne.jansen-thomas@uct.ac.za or 079 4949 411.
About the publishing organisations:
- Ilifa Labantwana is a national ECD programme, working to secure an equal start for all children living in South Africa, through universal access to quality early childhood development. www.ilifalabantwana.co.za
- The Children’s Institute contributes to policies, laws, and interventions that promote equality and improve the conditions of all children in South Africa through research, education, and technical support. www.ci.uct.ac.za | www.childrencount.uct.ac.za
- The Department of Planning, Monitoring and Evaluation in the Presidency was created to facilitate, influence and support effective planning, monitoring, and evaluation of government programmes aimed at improving service delivery, outcomes and impact on society. www.dpme.gov.za
- The Department of Basic Education deals with early childhood development and all schools from Grade R to Grade 12, including adult literacy programmes. The aim of the DBE is to develop, maintain and support a South African school education system for the 21st century. www.education.gov.za
- DataDrive2030 uses data tools and insights to drive greater access to better quality early learning for young children in South Africa. www.datadrive2030.co.za
- Grow Great is a national campaign that aims to mobilise South Africa to halve stunting in young children by 2030. Grow Great tackles the drivers of stunting in young children, pushing for national change while supporting local action. www.growgreat.co.za